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Free  HIV Test Request Form

We appreciate your engagement with our HIV Home Testing initiative. 

 

This testing option is accessible for individuals aged 17 and above, provided they fulfill the requirements below:
 

✅Live in Miami-Dade​

✅You must be 17 years of age or older

✅Have NOT tested positive for HIV in the past

✅Have NOT tested in the last two (2) months

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To ensure a comprehensive understanding of the home test process, please read the following information:

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  1. Kindly complete the request form provided below with utmost accuracy and submit it. This information is crucial for effective communication with you.

  2. Within a period of 24 to 48 hours, a testing counselor will contact you to verify the details provided in the form. They will also conduct a risk assessment by asking you standard questions typically included in routine HIV screenings. This phone call is expected to last approximately 5 to 10 minutes.

  3. Upon completion of the assessment, the testing counselor will discuss the method of delivery for an OraQuick home testing kit with you.

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Delivery options:

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  • In-hand Delivery: In most instances, a testing counselor will personally deliver the testing kit to your doorstep. It is important for you to be present at home to receive it. The package will contain an at-home testing kit and contact information of your counselor, including their full name, email address and work phone number. This information can be used to report your test results or address any other questions you may have. 

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  • Pick Up: If you prefer to personally pick up your home testing kit, the testing counselor will inform you of the location of the Center for Family and Child Enrichment and set a pick-up time & date. 

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  • By Mail: In certain cases, the testing kit can be mailed to your specified address. Please note that it may take up to 3 to 5 business days for the kit to arrive. If the test kit is mailed to you, your counselor will provide their contact information via email.

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Instructions:

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The OraQuick packaging contains the testing instructions. It is important to carefully follow the provided directions. The test should be conducted promptly upon receiving it, and the results should be reported to your counselor without delay.

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If you are prepared to begin, please complete the form below and submit your request.

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Free rapid HIV testing is available at the Center for Family and Child Enrichment location during weekdays, from Monday to Friday, between 9:00 AM and 4:00 PM.
 

Request Your No-Cost Home HIV Testing Kit
Get Your Free HIV Home Test Kit
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Terms & Conditions

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· I have never received a positive HIV test result before. I desire to undergo HIV testing using a no-cost rapid antibody home test kit that will be delivered to my doorstep. I consent to an initial phone conversation with an HIV testing counselor to discuss my potential risks, provide demographic information, and coordinate the delivery of the test kit.


· Once I receive the at-home test kit, I will carefully follow the provided instructions to perform the test accurately. If I require any assistance during the testing process, I will contact my testing counselor using the provided phone number.


· After conducting the HIV test and obtaining the result, I will promptly inform my testing counselor about the results. If more than 2 days have passed since the delivery of my package, my counselor will reach out to me for a follow-up. In the event that I reach my counselor's voicemail, I will leave my name and phone number for a callback.

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· I commit to honestly reporting my test results.


· I acknowledge that all the information shared during the phone conversations is confidential.


· If the test result is reactive, further confirmation testing will be required, which will be conducted in person at a nearby Pediatric & Family Health and Wellness Center location. At that point, additional information and consent forms will be collected by the Pediatric & Family Health and Wellness Center.


· Furthermore, my local Health Department will contact me to discuss my connection to HIV medical care as well as any sexual or needle-sharing partners. Voluntary partner services will also be offered to me.

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· I retain the right to withdraw my participation from the testing process at any time, and I will communicate this decision to my Testing Counselor via phone or email.


· I consent to allow the Pediatric & Family Health and Wellness Center to contact me regarding any eligible referrals.


· I have thoroughly read the Record Use and Release Consent.


· I have carefully reviewed the Client Rights and Responsibilities.


Consent and Accept:
 

Your request has been submitted successfully. Within a period of 24 to 48 hours, a testing counselor will contact you.

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